Pulp Therapy: Evidenced Based Recommendations for Primary and Permanent Teeth-Pulp Therapy Evidenced Based Recommendations for Primary and Permanent Teeth (Part 2)

Video Transcription

Video Summary

This comprehensive lecture reviews evidence-based approaches to pulp therapy in primary and permanent teeth, focusing on non-vital pulp therapy and vital pulp therapy advancements.<br /><br />For primary teeth with irreversible pulpitis, pulpectomy is recommended if there is no preoperative root resorption, as success rates are higher (88%) compared to teeth with root resorption (59%). Zinc oxide eugenol (ZOE) and Endofloss are preferred pulpectomy fillers, with Endofloss showing better resorption rates aligned with root resorption and higher success than Vitapex. Lesion Sterilization and Tissue Repair (LSTR) is advised for primary teeth with root resorption and offers better 12-month success than pulpectomy in such cases, although only short-term data exist. Clinical judgment is crucial when deciding between pulpectomy, LSTR, or extraction, particularly considering restorability and space maintenance.<br /><br />In permanent teeth, new guidelines suggest vital pulp therapy (VPT)—including indirect pulp treatment, direct pulp capping, partial, or full pulpotomy—can be successful in teeth diagnosed with irreversible pulpitis, even with spontaneous pain but no apical radiolucency. Calcium silicate cements like MTA, Biodentine, and CEM cement yield high success rates (up to 92%-97%) in pulpotomies. Full pulpotomy may have slightly better outcomes than partial pulpotomy in irreversibly inflamed teeth. Selective caries removal is preferred to minimize pulp exposures.<br /><br />In traumatic pulp exposures, partial pulpotomy shows high success (around 90%), outperforming direct pulp capping. Longer treatment delays (up to 72 hours) do not reduce success. Electrocautery for hemorrhage control may reduce clinical time but lacks evidence of improved outcomes.<br /><br />Overall, children's pulp therapies should be individualized, balancing evidence with clinical judgment, parental preferences, and treatment feasibility. Upcoming joint guidelines by the AAPD and AAE will formalize these recommendations, enhancing pediatric and general dental care for vital and non-vital pulp conditions.

Keywords

pulp therapy

primary teeth

permanent teeth

pulpectomy

irreversible pulpitis

root resorption

Zinc oxide eugenol

Endofloss

Lesion Sterilization and Tissue Repair

vital pulp therapy

calcium silicate cements

partial pulpotomy